Alyssa Lane
The Federal Employees Health Benefits (FEHB) Program is the largest employer-sponsored health benefits program, providing health insurance to nearly 8.3 million federal employees and dependents. The FEHB program offers a wide range of health plans, including consumer-driven, high-deductible, and fee-for-service options, as well as coverage for family members and dependents of federal employees. FEHB plans provide comprehensive coverage for medical expenses, preventive services, and prescription drug coverage, similar to Medicare. Enrollees can change their FEHB enrollment at any time, and the right plan depends on factors such as family composition, health status, and ability to meet out-of-pocket expenses.
| Characteristics | Values |
|---|---|
| Who is it for? | Federal employees, retirees, and their survivors |
| Who is eligible? | Federal employees, their family members and dependents, full-time temporary, seasonal, and intermittent federal employees |
| What does it cover? | Same kind of medical expenses as Medicare, plus a comprehensive range of preventive services and prescription drug coverage |
| What plans are available? | Consumer-driven, High Deductible, Fee-for-Service (FFS), Preferred Provider Organization (PPO), Health Maintenance Organization (HMO) |
| Can it be combined with other insurance? | Yes, with Medicare, TRICARE, or CHAMPVA |
| How many people does it cover? | 8.3 million federal employees and dependents |
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What You'll Learn
Federal Employees Health Benefits (FEHB) Program
The Federal Employees Health Benefits (FEHB) Program offers federal employees, retirees, and their survivors a wide range of health plans to meet their healthcare needs. It is one of the most comprehensive healthcare programs in the country, providing access to Consumer-Driven and High Deductible plans with catastrophic risk protection, health savings/reimbursable accounts, and lower premiums. Alternatively, Fee-for-Service (FFS) plans, Preferred Provider Organizations (PPO), or Health Maintenance Organizations (HMO) are available for those living or working within the serviced area.
FEHB plan brochures outline the services and supplies covered, as well as the level of coverage. These brochures can be obtained from health plans or the enrollee's human resource office. The program also provides access to Medicare Advantage plans and prescription drug coverage, ensuring that enrollees receive comprehensive healthcare support.
The FEHB Program is designed to be flexible and adaptable to meet the diverse needs of its members. For example, in certain situations, fee-for-service carriers may relax their pre-certification requirements, and carriers are encouraged to ensure that members have access to additional medication supplies in emergency situations.
The FEHB Program allows enrollees to change their plan or option once, starting 30 days before they become eligible for Medicare. This flexibility ensures that individuals can choose the most suitable plan based on factors such as family composition, health status, and ability to meet out-of-pocket medical expenses.
Overall, the Federal Employees Health Benefits (FEHB) Program is a comprehensive and flexible healthcare solution for federal employees and their families, offering a wide range of plan options and benefits to meet their unique healthcare needs.
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Medicare and FEHB
The Federal Employees Health Benefits (FEHB) Program offers federal employees, retirees, and their survivors a wide range of health plans. These include consumer-driven and high-deductible plans with catastrophic risk protection, health savings/reimbursable accounts, and lower premiums. It also includes fee-for-service plans and their Preferred Provider Organizations (PPO) or Health Maintenance Organizations (HMO) within the area serviced by the plan.
FEHB and Medicare can work together to meet healthcare needs, especially during retirement. Medicare is a health insurance program generally for individuals aged 65 or over, with two main parts: Part A (Hospital Insurance) and Part B (Medical Insurance). Medicare Part C, also known as Medicare Advantage, combines Parts A and B with additional benefits. Medicare Part D provides prescription drug coverage.
For federal employees, FEHB is typically the primary insurance, while Medicare becomes the primary payer after retirement. Retirees can choose to cancel or suspend their FEHB coverage when enrolling in Medicare. Cancelling is a permanent decision, while suspension allows for a temporary pause, providing the flexibility to reinstate FEHB coverage later.
FEHB and Medicare offer different coverage options, and enrollees can benefit from understanding how these options work together. For example, FEHB plans may offer benefits that complement the Medicare program, waiving certain costs like deductibles, coinsurance, and copayments. Additionally, FEHB plans provide prescription drug coverage, eliminating the need for enrollees to enroll in Medicare Part D separately.
It is important to note that qualified spouses, dependent children, and children with disabilities may be exempt from certain eligibility requirements when it comes to FEHB and Medicare coverage.
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TRICARE and FEHB
The Federal Employees Health Benefits (FEHB) Program offers a wide range of health plans for federal employees, retirees, and their survivors. It provides comprehensive coverage for various medical expenses, including preventive services and prescription drug coverage. On the other hand, TRICARE is a health care program designed specifically for active-duty military personnel, retired and former military personnel, and their dependents. It also covers dependents of deceased military personnel.
FEHB and TRICARE can be used together to enhance healthcare coverage. If an enrollee is covered by both FEHB and TRICARE, the FEHB plan serves as the primary payer, while TRICARE becomes the secondary payer. This coordination between the two programs ensures that individuals with dual coverage receive the benefits of both plans.
For military retirees who are also retiring from federal civilian service, combining TRICARE with an FEHB plan can be particularly advantageous. By enrolling in an FEHB plan during the Open Season, they can expand their healthcare network beyond TRICARE. This additional FEHB coverage can be especially useful for those who retire in remote geographic locations where accessing TRICARE providers may be challenging. With FEHB, they can opt for a plan that includes their preferred specialist, and the plan will cover most of the costs for those services.
It is important to note that individuals can suspend their FEHB coverage upon retirement and reactivate it during any subsequent Open Season. This flexibility allows retirees to manage their healthcare coverage according to their evolving needs. When suspending FEHB coverage to use TRICARE, individuals must inform the Office of Personnel Management (OPM) by submitting the required suspension form (RI 79-9). By strategically utilizing both programs, retirees can benefit from a broader range of healthcare options at a very low cost.
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Eligibility and enrolment
The Federal Employees Health Benefits (FEHB) Program offers a wide range of health plans to federal employees, retirees, and their survivors. Eligibility for the FEHB program is determined by the employee's agency, and certain requirements must be met to maintain eligibility.
Eligibility:
To be eligible for the FEHB program, one must fall under one of the following categories:
- Federal employee: Unless your position is excluded by law or regulation, you are eligible to elect FEHB coverage.
- Temporary employee: Employees on a temporary, seasonal, or intermittent schedule who work 130 hours per month or more for at least 90 days are eligible.
- Nonappropriated Fund (NAF) employee: NAF employees who transition to federal employment are eligible for FEHB coverage.
- Military personnel: TRICARE provides healthcare for active-duty military personnel, retirees, and their dependents.
- Annuitants: Federal annuitants and their surviving spouses can retain FEHB eligibility at the same cost as current employees if certain conditions are met.
- Former spouses: Under the Civil Service Retirement Spouse Equity Act, certain former spouses of federal employees may qualify for FEHB coverage.
- Members of Congress and congressional staff: Per the Affordable Care Act, they must purchase health benefits plans through the Small Business Health Options Program (SHOP).
Enrollment:
FEHB offers different types of enrollment to cater to individuals and families:
- Self Only: This enrollment provides benefits only for the enrollee.
- Self Plus One: This enrollment covers the enrollee and one eligible family member.
- Self and Family: This enrollment covers the enrollee and all eligible family members.
It is important to note that enrollees can change their FEHB enrollment to any available plan or option at any time, starting 30 days before they become eligible for Medicare. Additionally, certain life events, such as marriage, divorce, or the birth of a child, may allow for changes in enrollment outside of the annual Open Season. To maintain FEHB coverage into retirement, employees must be enrolled in the program for the five years preceding retirement or since their first opportunity to enroll.
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Types of health insurance plans
The Federal Employees Health Benefits (FEHB) Program is a type of health insurance plan available to federal employees, retirees, and their survivors in the United States. It offers a wide range of health plans, including consumer-driven and high-deductible options, as well as fee-for-service plans and health maintenance organizations (HMO). FEHB also provides coverage for prescription drugs and coordinates benefits with other programs such as TRICARE and CHAMPVA.
Health Maintenance Organization (HMO)
HMOs deliver health services through a network of healthcare providers and facilities. They typically require enrollees to have a primary care physician who coordinates their care and provides referrals to specialists. HMOs usually have lower premiums but offer less freedom in choosing healthcare providers.
Preferred Provider Organization (PPO)
PPOs offer a network of preferred providers with whom they have negotiated rates. While you can use out-of-network providers, staying within the network keeps costs lower. PPOs generally offer more flexibility in choosing healthcare providers but may have higher premiums or out-of-pocket costs for out-of-network services.
Exclusive Provider Organization (EPO)
EPOs are managed care plans that only cover services from doctors, specialists, or hospitals within their network, except in emergencies. EPOs typically have lower premiums but offer limited provider choices and may have higher out-of-pocket costs for out-of-network services.
Point of Service (POS)
POS plans allow enrollees to pay less when using in-network providers, but they also require referrals from a primary care doctor to see a specialist. POS plans offer a balance between the flexibility of a PPO and the cost-effectiveness of an HMO.
High-Deductible Health Plans (HDHP)
HDHPs are similar to catastrophic plans and are designed for individuals under 30 or those seeking lower insurance costs. They typically come with higher out-of-pocket costs but may be paired with a Health Savings Account (HSA) to help pay for eligible medical expenses tax-free. HDHPs often have lower premiums and can be found at various metal levels, such as Bronze, Silver, Gold, and Platinum.
Marketplace or ACA Plans
These plans are sold on the health care Marketplace or Exchange and are designed to make health insurance more accessible. They focus on preventive care, cover pre-existing conditions, and provide benefits for doctor visits, prescriptions, and lab tests. Enrollment periods typically apply to these plans.
Medicare
Medicare is a federally funded program originally designed for individuals 65 and older but has since expanded to include disabled people under 65 and those with special circumstances. It is divided into four parts (A, B, C, and D) and offers comprehensive coverage for hospital care, doctor services, prescription drugs, and more.
Medicaid
Medicaid is a federal and state program that provides health coverage for low-income families, seniors, and individuals with disabilities. Eligibility is based on meeting federal income standards, and the program may have different names in different states.
These are some of the primary types of health insurance plans available. Each plan has unique features, benefits, and considerations, so it is essential to review and select the one that best fits your specific needs and budget.
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Frequently asked questions
Federal Employees Health Benefits.
Federal employees, retirees, and their survivors. Family members and dependents of federal employees, as well as full-time temporary, seasonal, and intermittent federal employees, may also be eligible.
FEHB covers the same kind of medical expenses as Medicare, plus a comprehensive range of preventive services and prescription drug coverage.
Your agency dictates the rules and your eligibility. Check with your Human Resources Office if you are unsure.
Yes, but there are many factors to consider before electing both forms of coverage. One advantage of having both is the coordination of benefits, which may reduce out-of-pocket costs.
